OBJECTIVES:
To assess the performance of the Milan, Shanghai Fudan and Hangzhou Criteria based on preoperative evaluation in patients undergoing liver transplantation (LT) for hepatitis B-related hepatocellular carcinoma (HCC).

METHODS:
Using a prospectively collected database, data of consecutive patients with hepatitis B-related HCC undergoing LT from January 2005 to December 2009 were reviewed. Overall survival and tumor recurrence rates of patients fulfilled Milan, Shanghai Fudan and Hangzhou Criteria were compared using the log-rank test.

RESULTS:
Altogether 148 patients were enrolled in the study, in which 88 fulfilled the Milan criteria, 24 and 39 were beyond Milan but within Shanghai Fudan or Hangzhou criteria, respectively. After followed up for a median period of 44 months, survival rates did not differ among the three groups (P = 0.8780). Recurrence rates was significantly lower for newly eligible patients by Shanghai Fudan or Hangzhou Criteria compared with those within the Milan Criteria.

CONCLUSIONS:
The Milan criteria should be applied as the preferred criteria of hepatitis B-related HCC. Moderate expansion of Milan criteria must be performed cautiously considering high tumor recurrence rates and donor scarcity until high quality clinical trials are conducted.